This study investigated the incidence and risk factors for hospitalization-associated disability (HAD) in a rural general hospital. To investigate the incidence of HAD, we compared the activities of daily living (ADL) of inpatients between the time of admission to the Department of General Medicine, Ohchi Municipal Hospital and discharge. We also evaluated nutritional status, cognitive function, blood examinations, presence or absence of care certification at the time of admission, and length of hospital stay in order to analyze the relationship with onset of HAD. HAD was observed in 8 of 53 patients (15%). These 8 patients were significantly older and had lower ADL scores, poor nutritional status, cognitive function, and serum albumin levels. Nutritional status and cognitive function were independent risk factors for HAD in multivariate logistic regression analysis. In addition, all patients with HAD possessed care certification. The incidence of HAD in this study was 15%, which is lower than that reported in other countries. Poor cognitive function and nutritional status appear to be risk factors for HAD, independent of age and ADL at admission.